Provider Demographics
NPI:1760268627
Name:WATTS, ALYCE OSBORNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:OSBORNE
Last Name:WATTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5893 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-4007
Mailing Address - Country:US
Mailing Address - Phone:770-880-7219
Mailing Address - Fax:
Practice Address - Street 1:5893 ALPINE CT
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4007
Practice Address - Country:US
Practice Address - Phone:770-880-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical